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It is essential that one defines euthanasia in terms of the â€˜good of the subjectâ€™ or that â€˜death is no evil to himâ€™ . For if euthanasia was to mean simply â€˜a quite and easy deathâ€™ or â€˜the means of procuring thisâ€™ as the ancient Greeks supposed an ambiguity with awkward consequences results. Foot uses the example of a murderer, careful to drug his victim, claiming on apprehension, that his act was merely euthanasia. Euthanasia therefore must be a benefit to the subject. This point is imperative in understanding the permissibly of the two forms of euthanasia which I regard moral . Therefore euthanasia, in this essay, will be defined as bringing about the death (foreseeable or unforeseeable) of another with the intention of preventing needless suffering. Where suffering is unbearable physical pain associated with a terminally ill patient or a comatose person unable to regain consciousness.
The first form of euthanasia that I deem permissible is â€˜passive nonvoluntary euthanasiaâ€™. Passive nonvoluntary euthanasia (henceforth simplified as passive euthanasia) occurs when a patient dies due to either, a medical profession not performing a certain action that would keep the patient alive, or abstaining from an action that is keeping the patient alive. An example of the earlier would be switching off life-support machines or disconnecting a feeding tube. And examples of the latter would include not carrying out life-extending operations or withholding life-extending drugs.
There are two reasons why I suppose this permissible. The first is beneficence due to the loss of autonomy. Autonomy is defined as the \\"the right of self government or personal freedomâ€? . Here personal freedom is defined as the means to consciously and rationally attain a desired end. Personal freedom then is a prerequisite of the right of self government.
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The second reason why I consider passive nonvoluntary euthanasia morally permissible, results from the argument of Non-maleficence. This argument closely allies, though not quite the same, with that of the pervious argument, beneficence. The consequent of relying or extraordinary mean for survival results in the domino effect from the \\"prolongation of living into the prolongation of dying\\" . This again seems to derive from an intrinsic fear of death by dire definition. When we extend the process of death we are doing no good to the subject in question. To live as long as technology and modern medicine can keep us, even when we know that the chance of regaining consciousness is naught, to me is wrong if not unnatural. Death is inevitable. It is part or every life. And so it seems to me that if death comes knocking on your door and you open it, then decide to slam it shut (by means of life-support machines), death will always find another way to welcome itself home. Therefore it becomes more of an evil to prolong the inevitability of death. And morally acceptable to end life under such circumstances.
The other form of euthanasia that I judge morally permissible is that of indirect euthanasia. Indirect euthanasia is defined as providing treatment (usually to reduce pain) that has the side effect of speeding the patient\\'s death. Since the primary intention is not to kill, this form is also morally permissible. It must be noted here that this particular form of euthanasia is morally permissible when that small percent of patients do not respond to palliative care. And only ever considered when consistent with the definition of euthanasia as defined above.
These arguments are by no means perfect. For that reason I will now turn the implications that arise from each. The most important objection to the argument of permissibility is that of the distinction between active and passive euthanasia. The objection is that there is no moral difference between killing someone and allowing someone to die. Rachels uses the following example. A child is taking a bath. When (a) his cousin Smith sneaks into the bathroom and drowns the child, and then arranges things as to look like an accident. And when (b) Jones who also stands to profit if anything should happen to his cousin, sneaks into the bathroom, with the intent to drown. However just as he enters the bathroom Jones sees the child slip and hit his head, falling face down in the water, without the prospect of regaining consciousness unless perhaps if Jones pulls him out from the water. Jones of course does not help the child. Rachels goes on to say â€˜the bare difference between killing and letting die does not, in itself, make a moral difference. The implication in this case then is to permit active euthanasia.
Why then do I not hold active euthanasia as morally permissible? It is my belief that Rachelsâ€™ example is incongruous, that his moral point of view is unrelated to the context of the argument for passive nonvoluntary euthanasia, and therefore not an objection to my arguments at all. I think this way for two reasons. The first being because the child has not, from the point before being drowned or hitting his head, lost his autonomy. The boy was an autonomous being, who had the right to self-government. The second reason is due to the following. In example (a) Smith has committed cold blooded murder, an act of injustice . In example (b) Jones commits an act not against justice but in contradiction with charity. â€˜A culpable failure to come to the aid of someone whose life is threatened is normally contrary, not to justice, but to charityâ€™ . This I take to be of great importance when voluntary active euthanasia is distinguished to passive nonvoluntary euthanasia.
What of indirect euthanasia, how can this be adequately defended against the claim that this is no different from active euthanasia? The essence of the argument that there is a difference between active euthanasia and knowingly shortening a patientâ€™s life as a side effect of treating their suffering is intention. Some have argued in the past that intention must include any foreseen, or foreseeable, consequences of oneâ€™s actions, but this definition has long since been recognized as unsound. If I get drunk, knowing that I may have a hangover the next morning, I do not intend to get a hangover. In the same way, if a physician prescribes analgesics or sedatives in a dose that she knows may shorten the life of the terminally ill patient, but her intention is to alleviate the suffering of the patient and this is the only way to do it, she is not morally wrong. In the same way the withholding of life-prolonging treatment or â€˜letting dieâ€™, E.g. antibiotics for an end-stage cancer patient who has developed pneumonia, does not have the intention of shortening the patientâ€™s life, only abstention from unnecessarily prolonging the life and suffering of the patient.
Another important objection regarding the argument from benefice is that even with the best palliative care, and the best pain management, that there will still be a small group of patients for whom there is no relief from their suffering, and so for whom the most humane option is to end their life. However, it is doubtlessly true that physicians and the medical care system in general are not adequately treating the pain and suffering of terminally ill patients. While euthanasia may be a compassionate act in a handful of extreme cases, this does not mean it morally permissible.
â€˜There can be good deaths and bad deathsâ€™, a medical practitioner remarks. â€˜A bad death is when a person has not accepted death as much a part of life as living. And a good death is when a person has come to the realization that death is just another card to play in the game of lifeâ€™ . Perhaps due to deaths dire definition coupled with the fear of dying, one may wish the heart was a voluntary muscle. It is of course not and is the author belief that in only two circumstances, outline above, that life ever be supported to end.
James Rachels- Moral Philosophy